Provider Demographics
NPI:1932402328
Name:HORTON, PATRICE RENEE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:PATRICE
Middle Name:RENEE
Last Name:HORTON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 HUNTINGDON CHASE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-4930
Mailing Address - Country:US
Mailing Address - Phone:706-304-4376
Mailing Address - Fax:
Practice Address - Street 1:1260 HIGHTOWER TRL
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30350-6248
Practice Address - Country:US
Practice Address - Phone:678-926-2448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-07
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004290225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAOT004290OtherOCCUPATIONAL THERAPY LICENSE